Influence of perinatal antibiotic on neonatal gut microbiota: a prospective cohort study

INTRODUCTION: Given the significant role of the gut microbiota in early immune and metabolic development, the impact of perinatal antibiotic administration on the neonatal gut microbiome remains a crucial area of investigation. This study examines how maternal and neonatal antibiotic exposure affects the composition of the gut microbiome in preterm infants. METHODOLOGY: A prospective controlled cohort study was conducted in the neonatal intensive care unit of a tertiary care hospital from January 2021 to September 2023. The study enrolled neonates with a gestational age of less than 37 weeks. Preterm infants were categorized into four groups based on exposure to maternal or neonatal antibiotics: the NE group (no exposure), IE group (infant exposure only), ME group (maternal exposure only), and IME group (both infant and maternal exposure). In the NE group, "No exposure" refers to participants whose mothers did not receive intrapartum antibiotics or whose neonates were not administered postnatal antibiotics prior to sample collection. Data on antibiotic use and microbiota composition from stool samples were collected and analyzed via the convection culture method. RESULTS: This study included 182 preterm infants, yielding 364 stool samples. By day 4, the prevalence of Klebsiella pneumoniae increased significantly, reaching 70% in the IE group compared with 42.6% in the NE group (p < 0.001). Bifidobacterium spp. was more prevalent in the NE group than in the other groups on day 4 (57.4%, p = 0.019). The antibiotic-exposed groups (IE, ME, and IME groups) presented greater abundances of potentially pathogenic bacteria, such as Klebsiella pneumoniae and Escherichia coli, whereas beneficial bacteria, such as Bifidobacterium spp., were more abundant in the NE group. CONCLUSION: These findings suggest that perinatal antibiotic exposure is associated with significant changes in the neonatal gut microbiota, potentially increasing the pathogenic microbiota. TRIAL REGISTRATION: The study was registered with the Clinical Trials Registry-India (CTRI) under the number CTRI/2020/11/029375 | http://ctri.nic.in/ on November 19, 2020.